[Coronary arteriography and long-term prognosis in postero-inferior infarction. Methodological reflections apropos of a preliminary retrospective survey].
Most studies of the long term prognosis after myocardial infarction take only parameters reflecting the quantity of necrosed cardiae muscle and the resulting disturbances in left ventricular function into account. Coronary arteriography should give a more precise assessment by the detection of stenoses on arteries supplying healthy myocardium, especially in small infarcts. This concept was tested in a retrospective study of 100 patients investigated 1 to 12 months after inaugural posterior or inferior myocardial infarction between 1970 and 1979, and followed-up for an average of 32,5 months. THe survival curves of subgroups defined by angiographic parameters were compared by Mantel's method. The 5 year survival rate was 91,2 +/- 3,4%, corresponding to a mortality of 26 deaths per 1000 patients year. This very low mortality rate may be related on the one hand to the selection of the patients, especially those investigated at a distance from the infarct, and on the other hand, to the role of drug therapy. The number of patients required to compare two therapeutic protocols would be necessarily high because of the low overall mortality. The 5 year survival rate without a serious cardiac event (death, recurrent infarction, deterioration to Stages III or IV of the NYHA Classification, acute coronary insufficiency), was 76,8 +/- 6.4%. The only discriminating angiographic sign in this study was the number of diseased vessels: triple vessel disease significantly increased the risk of a serious cardiac event, (p less than 0,04). The preliminary results have led to the establishment of a stricter protocol designed to improve the indications of coronary arteriography in postero-inferior infarction.
D000792:Angiography; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000401:mortality; D011379:Prognosis; D012189:Retrospective Studies
Artériographie coronaire et pronostic à long terme des infarctus postéro-inférieurs. Réflexions méthodologiques à propos d'une enquête rétrospective préliminaire.